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Membership Information Update

Membership Information

Membership Level : 
Membership Type : 

Primary Member Information

Last Name : 
First Name : 
 MI 
Birthdate : 
 (MM/DD/YYYY)
Marital Status : 
Gender : 
 Male    Female
Address : 
City, State, Zip : 
, 
Home Phone : 
 (555-555-5555)
Email Address* : 
Areas of Interest : 
 
 
 
 
 
 
 
 
 
 
 
 
 

Occupation : 
Business Name : 
Business Address : 
City, State, Zip : 
, 
Business Phone : 
 (555-555-5555)
Business Email : 


Spouse

Last Name (if different) : 
First Name : 
 MI 
Birthdate : 
 (MM/DD/YYYY)
Gender : 
 Male    Female
Email Address : 

Business Name : 
Business Address : 
City, State, Zip : 
, 
Business Phone : 
 (555-555-5555)
Business Email : 


Children

First Name : 
 MI 
Last Name (if different) : 
Gender : 
 Male    Female
Birthdate : 
 (MM/DD/YYYY)
School : 

First Name : 
 MI 
Last Name (if different) : 
Gender : 
 Male    Female
Birthdate : 
 (MM/DD/YYYY)
School : 

First Name : 
 MI 
Last Name (if different) : 
Gender : 
 Male    Female
Birthdate : 
 (MM/DD/YYYY)
School : 

First Name : 
 MI 
Last Name (if different) : 
Gender : 
 Male    Female
Birthdate : 
 (MM/DD/YYYY)
School : 

Voluntary Information

Religion : 
 Jewish    Non-Jewish
Synagogue : 
Why did you join the MJCCA?
 The Weinstein School
 The Sunshine School
 Camp Marie Benator
 Camp Billi Marcus
 Camp Isidore Alterman
 Camp Barney Medintz
 BSO Camp Chai
 After-School Care
 BBYO / Teen Connection
 Children's Sports
 Teen Sports
 Adult Sports
 Developmental Disability Programs
 Fitness
 Trips & Excursions
 Social Gatherings
 Educational Classes
 Support Jewish Community
How did you hear about the MJCCA?
 Referral by a Friend 
 Advertisment in 
 Promotion 
 Other 

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The MJCCA’s Inclusion Program strives to provide the necessary accommodations and flexibility for youth who require additional support so they may access the transformative opportunities available at the MJCCA. Our Inclusion Team collaborates with parents, educators, and staff to determine if successful program placement is possible. These youth and their families are then supported by our Inclusion Team through program accommodations and may also receive individualized assistance. Click here for more information.